thromboxane-b2 and Budd-Chiari-Syndrome

Venous prostheses have poor long-term patency; to improve this situation, experimental studies have been carried out.. Methods of endothelial cell harvesting, prosthetic seeding and implantation mainly in the inferior vena cava were studied in 127 dogs. Evaluations were conducted by angiography, gross appearance, light, scanning and transmission electron microscopic observations, histo-fluorescent staining, as well as radioimmunoassay.. It was found that at five to ten days following implantation, the prosthetic endothelialisation could be reliably achieved in the seeded group and a 100% patency of the seeded inferior vena caval prostheses was attained at 100 days. The thickness of the neointima in the seeded group at 10 and 100 days was 299 microm and 302 microm, respectively. The metabolite of PGI2 from extrinsic arachidonic acid, 6-keto PGF1a, produced by cells from seeded graft was significantly higher than that from spontaneously formed cells and the reverse found with thromboxane B2. A temporary (one week) distal (femoral) arteriovenous fistula enhanced graft patency. These results indicated that the early endothelialisation of grafts by seeding enhanced the patency and inhibited intimal hyperplasia of venous prostheses. The clinical outcome was impressively improved from our previous experience with ten of eleven venous grafts patent over a follow-up period of six to nine years. These might result from the realization of early endothelialisation and its cells derived from seeding being able to produce significantly more PGI2 and less thromboxane B2.. The endothelial cell seeding technique may bring us much closer to an ideal venous prosthesis.

Topics: Adolescent; Adult; Animals; Blood Vessel Prosthesis; Budd-Chiari Syndrome; Coated Materials, Biocompatible; Dogs; Endothelium, Vascular; Epoprostenol; Female; Fibromuscular Dysplasia; Follow-Up Studies; Graft Occlusion, Vascular; Humans; Male; Microscopy, Electron, Scanning; Middle Aged; Prosthesis Design; Thromboxane B2; Vena Cava, Inferior

One hundred and eleven mongrel dogs were used for this study. Endothelial cells were harvested from jugular vein or omentum with methods of collagenase digestion and density gradient separation. Animal model of prosthetic interposition into the inferior vena cava with or without distal arteriovenous fistula was established. The complete endothelialization was established 5 to 10 days following a high density seeding. The neointimal hyperplasia was inhibited. A 100-day 100% patency of prosthesis was reached. The seeded endothelium secreted higher level of PGI2 than normal control and lower level of TXB2, hence the positive effect of distal AVF functioning for a week on the patency was demonstrated. This method used in 10 cases with Budd-Chiari syndrome resulting in good outcome after 3 to 5 years follow-up. We conclude that the endothelial seeding technique has a promising future using in the venous circuit.

Topics: Adolescent; Adult; Animals; Blood Vessel Prosthesis; Budd-Chiari Syndrome; Dogs; Endothelium, Vascular; Epoprostenol; Female; Follow-Up Studies; Humans; Male; Middle Aged; Thromboxane B2; Vascular Patency; Vena Cava, Inferior